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Nursing Excellence

The Online Newsletter for Children's Nurses
e-Edition, Volume 1, Issue 3 

Elaine Alexander
Change and Transition

Elaine Alexander BSN, RN,
Clinical Practice Coordinator,Accreditation and Regulatory Compliance

As an organization embarks upon change many people may feel uncertainty. Amidst the uncertainty and change related to transformation, some things remain unchanged. The organizations “spirit”— its core purpose or unique reason for being—remains the same (Ackerman-Anderson & Anderson, 2005).

Reflection of our hospital’s “spirit” includes our mission, vision and core values. Our mission – “providing high quality, comprehensive healthcare service to the children of Central California, regardless of their ability to pay”; our vision - “to partner with its physicians to become the pre-eminent provider of pediatric services for Central California and the Western United States, and indisputable resource for healthcare solutions, information, and advocacy for children in an expanding pediatric marketplace”; our core values of excellence, compassionate care, integrity, innovation, collaboration, and stewardship all reflect the Hospital’s “spirit”. Ackerman-Anderson and Anderson (2005) state, “Core purpose, along with shared vision and shared values, become the DNA that leaders can use to carry the organization from its past, through the uncertainty, into its tangible future.”

Kotter (1996) identified eight steps in leading organization change which can be used at any level within the organization to support the change process. Kotter’s steps are:


1. Establish a sense of urgency

  • Unfreeze the organization by creating compelling reasons why change is needed.

2. Create the guiding coalition

  • Create cross-functional, cross-level groups of people with enough power to lead change.

3. Develop a vision and strategy

  • Create a vision and strategic plan to guide the change process.

4. Communicate the change vision

  • Create and implement a communication strategy that consistently communicates the new vision and strategic plan.

5. Empower broad-based action

  • Eliminate barriers to change, and use target elements of change to transform the organization. Encourage risk taking and creative problem solving.

6. Generate short-term wins

  • Plan for and create short –term “wins” or improvements. Recognize and reward people who contribute to the wins.

7. Consolidate gains and produce more change

  • The guiding coalition uses credibility from short-term wins to create more change. Additional people are brought into the change process as change cascades throughout the organization. Attempts are made to reinvigorate the change process.

8. Anchor new approaches in the culture

  • Reinforce the changes by highlighting connections between new behaviors and processes and organizational successes. Develop methods to ensure leadership development and succession.

An organization experiences growing pains while transitioning through the change process. Change is considered the structural or external process whereas transition is the internal psychological reorientation that people have to go through before the change can work (Bridges, 2000). People respond and react to change differently. Bridges (2000) identified three phases of transition: endings, neutral zone, and new beginnings.

According to Bridges (2000) the first phase - endings, is considered as a time of saying good-bye to the past and the old way of doing things. The neutral zone is a time of chaos; the in-between state and feelings of being in limbo. The neutral zone is where most energy is spent. The last phase is new beginnings or moving forward and embracing new processes and new behaviors.

As Children’s Hospital embraces the change and transition from MEDITECH Magic to Client Server, Lawson, and Morrissey, focus on the opportunities of what the outcomes will be. Consider the mission and vision and core values of the organization and how the opportunity to expand on the elements will enhance patient care and professional practice. Focus on the fact that Children’s Hospital will provide an enhanced or refined service to the internal and external customers of the organization; Focus on the opportunity to increase performance through quality outcomes and initiatives with improved data. Focus on how changes made today will provide safer care for patients tomorrow.

Magnet LogoChildren’s Hospital has Amazing People and provides Incredible Care.


References Ackerman-Anderson L., & Anderson D., (March 2001). Beyond change management: strategies for today’s transformational leaders. San Francisco: Jossey Bass. Bridges, W., & Bridges S. M., (2000). Leading transition: a new model for change. Leader to Leader. Retrieved August 17, 2009 from Kotter, J. (1996). Leading Change. Boston: Harvard Business School Press



In This Issue
Seasons of Change
Change and Transition
Career Path to Success
Decreasing Medication Errors Through Reporting of Unusual Occurrences
Demystifying Simulation
Breastfeeding: Improving the Health of Baby and Mom
Addressing Parent’s Fear of the MMR Vaccine
NICU Nursing in Nepal